Carotid ultrasound in clinical practice

Abstract

Objectives: to review up-dated criteria for decision making in extracranial cerebrovascular disease treatment and to review the indications for laboratory imaging studies, such as triplex scan, and the proper use of the data supplied by this examination. Methods: revision in manuals, periodic journals and electronic data bases related to vascular surgery, neurology, primary care medicine and others of accepted general importance, with special interest in the last five years. Conclusions: criteria for decision making in extracranial cerebrovascular disease therapy come from multicentre randomised studies and depend, most of all, on the degree of internal carotid stenosis and on the presence of neurological symptoms ipsilateral to the diseased artery. Formal indication for carotid endarterectomy stands in the group of symptomatic patients with a degree of stenosis of 70% or more, and in the group of asymptomatic patients with a degree of stenosis of 80% or more. The latter indication for asymptomatic patients is highly dependent on operative risk. Concerning the use of laboratory imaging studies, carotid triplex scan is now considered for most patients as accurate and sufficient for the identification and characterisation of carotid stenosis. This exam is harmless and has an important role in patients with symptoms suggesting cerebrovascular disease, in patients with coronary or peripheral artery disease, and possibly in those with risk factors for atherosclerosis. In selected patients there is indication for arteriography, namely in cases of suspected intracranial disease or proximal intrathoracic carotid disease, on which triplex scanning does not supply the necessary data.